Electrosurgical instrument and system

ABSTRACT

An electrosurgical system includes an electrosurgical instrument and an electrosurgical generator, the instrument having a longitudinal axis and including at least first, second and third electrodes. The electrodes are spaced from each other by one or more insulating members therebetween, the spacing between the first and third electrodes being greater than that between the first and second electrodes. The electrosurgical generator includes a source of radio frequency energy capable of producing either a coagulating RF waveform or a cutting RF waveform and has first second and third output connections connected to the first, second and third electrodes respectively of the electrosurgical instrument. The generator further includes a switching means, and a controller, the controller being such that when a cutting RF waveform is selected, the switching means directs the cutting RF waveform between the first and second output connections and hence the first and second electrodes. When a coagulating RF waveform is selected, the switching means directs the coagulating RF waveform between the first and third output connections and hence the first and third electrodes.

This application claims the benefit of U.S. Provisional Application No.61/282,382, filed Feb. 1, 2010, and is a continuation-in-part of U.S.application Ser. No. 12/585,457 filed Sep. 15, 2009, which claimspriority to UK 0817920.2 filed 30 Sep. 2008 and claims the benefit ofU.S. Provisional Application No. 61/136,850, filed Oct. 8, 2008, theentire contents of each of which are hereby incorporated by reference.

FIELD OF THE INVENTION

This invention relates to an electrosurgical system comprising agenerator and an electrosurgical instrument including electrosurgicalelectrodes for receiving radio frequency (RF) power from the generator.Such systems are commonly used for the cutting and/or coagulation oftissue in surgical intervention, most commonly in “keyhole” or minimallyinvasive surgery, but also in “open” surgery.

BACKGROUND OF THE INVENTION

The criteria for an effective cutting instrument are different fromthose required for an effective coagulating instrument. U.S. Pat. No.6,004,319 attempts to deal with this problem with a pair of electrodeswhich are designed to be capable of operating effectively in either acutting or coagulation mode.

SUMMARY OF THE INVENTION

The present invention provides an alternative solution to the aboveproblem and, according to one aspect, constitutes an electrosurgicalsystem including an electrosurgical instrument and an electrosurgicalgenerator, the electrosurgical instrument including at least first,second and third electrodes, each spaced from each other by insulatingmembers therebetween, the first electrode having a characteristic suchthat it is adapted to constitute an active electrode, the secondelectrode having a characteristic such that it is adapted to constitutea first return electrode, and the third electrode having acharacteristic such that it is adapted to constitute a second returnelectrode, the electrosurgical generator including a source of radiofrequency energy capable of producing either a coagulating RF waveformor a cutting RF waveform, and first, second and third output connectionsconnected to the first, second and third electrodes respectively of theelectrosurgical instrument, the generator further including a switchingmeans and a controller, the controller being such that when a cutting RFwaveform is selected, the switching means directs the cutting RFwaveform between the first and second output connections and hence thefirst and second electrodes, and when a coagulating RF waveform isselected, the switching means directs the coagulating RF waveformbetween the first and third output connections and hence the first andthird electrodes.

The generator uses the same electrode as an active electrode for bothcutting and coagulation, but switches between using the first returnelectrode when RF cutting is required, and the second return electrodewhen RF coagulation is required. The first and second return electrodescan be designed so as to be particularly suitable for their intendedpurpose, and there is accordingly no need to use the same returnelectrode for both cutting and coagulation.

This arrangement differs from the arrangements described in U.S. Pat.No. 6,984,231, as in the present arrangement the same active electrodeis used for both cutting and coagulation. In the embodiments of thesystem disclosed in U.S. Pat. No. 6,984,231, the electrode employed asan active electrode in the cutting operation is not employed at all inthe coagulation operation.

Preferably, the spacing between the first and third electrodes isgreater than that between the first and second electrodes. Furthermore,the characteristic that adapts the first electrode to constitute anactive electrode is preferably the electrode area, as is thecharacteristic that adapts the second and third electrodes to constitutereturn electrodes. Preferably, the area of the first electrode is lessthan that of the third electrode. Conveniently, the area of the firstelectrode is also less than that of the second electrode. In onearrangement, the area of both the first and second electrodes is lessthan that of the third electrode.

With the area of the electrodes determining which electrode willconstitute the active electrode and which the return electrodes, theinstrument is designed such that the distance between the activeelectrode and the return electrode that is used during the cuttingoperation is relatively small, so as to promote relatively high electricfield intensities over a relatively small area. This promotes effective“firing-up” of the cutting electrode, especially where the instrument isused in a wet field or “underwater electrosurgery” environment, in whichthe instrument is used immersed in an electrically conductive fluid.Conversely, the instrument is designed such that the distance betweenthe active electrode and the return electrode that is used during thecoagulation operation is relatively large, so as to provide coagulationover a relatively large area of tissue. The relatively small electrodeseparations used for effective known cutting instruments mean that anycoagulation produced when these known instruments are used in thecoagulation mode is restricted to a very small area, and hence they makevery poor coagulators. The benefit of the electrosurgical systemdescribed herein is that a small electrode separation is used forcutting, but a larger electrode separation is used for coagulation. Thusboth effective cutting and coagulation can be provided from the sameinstrument, by means of the use of different return electrodes for eachoperation.

In a convenient arrangement, the third electrode is axially set backwith respect to the first and second electrodes along the longitudinalaxis of the electrosurgical instrument. Typically, the second electrodeis also axially set back with respect to the first electrode along thelongitudinal axis of the electrosurgical instrument, so as to provideall three electrodes axially spaced along the instrument. In somearrangements, conceivably more than three electrodes are provided, eachadditional electrode providing subsequently different degrees ofelectrode separation, for differing cutting or coagulation effects.

In one convenient arrangement, when a coagulating RF waveform isselected, the switching means directs the coagulating RF waveformbetween the first output connection and both the second and third outputconnections and hence the first electrode and both the second and thirdelectrodes. In this way both return electrodes are used in thecoagulation process, giving both relatively precise coagulation betweenthe first and second electrodes, and relatively broad coagulationbetween the first and third electrodes.

Conceivably, the generator is provided with a blend mode in which theswitching means directs the cutting RF waveform between the first andsecond output connections and hence the first and second electrodes, andalso directs the coagulating RF waveform between the first and thirdoutput connections and hence the first and third electrodes. Thisprovides a combined cutting and coagulation effect, in which tissue iscut and coagulated at the same time. In one arrangement, the generatordirects the cutting RF waveform between the first and second outputconnections and hence the first and second electrodes simultaneouslywith directing the coagulating RF waveform between the first and thirdoutput connections and hence the first and third electrodes. This mayrequire the use of more than one radio frequency source, or the use ofRF signals at different frequencies, to avoid the RF cutting waveforminterfering with the RF coagulation waveform. Alternatively, thegenerator alternates rapidly between directing the cutting RF waveformbetween the first and second output connections and directing thecoagulating RF waveform between the first and third output connections.With a sufficiently rapid alternation between the cutting andcoagulating waveforms, a simultaneous tissue effect is achieved withoutthe cutting waveform and the coagulating waveform interfering one withthe other.

According to an alternative aspect of the invention, there is providedan electrosurgical system including an electrosurgical instrument and anelectrosurgical generator, the electrosurgical instrument including atleast first, second and third electrodes, each spaced from each other byinsulating members therebetween, the electrosurgical generator includinga source of radio frequency energy capable of producing either acoagulating RF waveform or a cutting RF waveform, and first second andthird output connections connected to the first, second and thirdelectrodes respectively of the electrosurgical instrument, the systemfurther including a switching means, and a controller, the controllerbeing such that when a cutting RF waveform is selected, the switchingmeans directs the cutting RF waveform between the first and secondoutput connections and hence the first and second electrodes, and when acoagulating RF waveform is selected, the switching means directs thecoagulating RF waveform between the first and third output connectionsand hence the first and third electrodes, the first electrode having acharacteristic such that it is adapted to constitute an activeelectrode, the third electrode having a characteristic such that it isadapted to constitute a return electrode, and the second electrodehaving a characteristic such that it is adapted to constitute a eitheran active electrode or a return electrode, depending on thecircumstances.

In this way, the second electrode sometimes acts as an active electrodeand at other times acts as a return electrode. In one convenientarrangement, the second electrode is adapted to constitute a returnelectrode when the cutting RF waveform is supplied between the first andsecond output connections. In the other situation, the second electrodeis adapted to constitute an additional active electrode when thecoagulating RF waveform is supplied between the first and third outputconnections. Preferably, the switching means connects the first andsecond output connections in common when the coagulating RF output issupplied between the first and third output connections. In thisarrangement, coagulation can take place between the first and thirdelectrodes, and also between the second and third electrodes.

According to a further aspect of the invention an electrosurgicalinstrument is provided including at least first, second and thirdelectrodes, each spaced from each other by insulating memberstherebetween, the first electrode having a characteristic such that itis adapted to constitute an active electrode, the second electrodehaving a characteristic such that it is adapted to constitute a firstreturn electrode, and the third electrode having a characteristic suchthat it is adapted to constitute a second return electrode, theinstrument having a first set of connections by which the firstelectrode can be placed in circuit with the second electrode such thatin use a current path is established between the first and secondelectrodes, and a second set of connections by which the first electrodecan be placed in circuit with the third electrode such that in use acurrent path is established between the first and third electrodes, thefirst, second and third electrodes being arranged such that if astraight line is drawn representing the shortest distance between thefirst and second electrodes, no part of the third electrode lies on thatstraight line, and if a straight line is drawn representing the shortestdistance between the first and third electrodes, no part of the secondelectrode lies on that straight line, such that the third electrode isnot in the current path between the first and second electrodes when thefirst and second electrodes are in use, and the second electrode is notin the current path between the first and third electrodes when thefirst and third electrodes are in use.

By providing two electrodes available to act as a return electrode,either of these two electrodes can be excluded from the treatmentcurrent circuit at any one time. However, it has been found that theun-used return electrode still has an effect on the current flow if itis in the path between the two electrodes that are in circuit,especially where the instrument is used in a wet field or “underwaterelectrosurgery” environment, in which the instrument is used immersed inan electrically conductive fluid. Moreover, this effect on the currentflow may be detrimental to the efficient operation of the instrument,diverting current via the un-used return electrode. By arranging the tworeturn electrodes to be displaced from one another so that the un-usedelectrode is not in the current path between the two electrodes that arein use, this detrimental effect can be avoided.

According to a further aspect of the invention, an electrosurgicalsystem is provided, the electrosurgical system including anelectrosurgical instrument and an electrosurgical generator, theelectrosurgical instrument including at least first, second and thirdelectrodes, each spaced from each other by insulating memberstherebetween, the first electrode having a characteristic such that itis adapted to constitute an active electrode, the second electrodehaving a characteristic such that it is adapted to constitute a firstreturn electrode, and the third electrode having a characteristic suchthat it is adapted to constitute a second return electrode, theelectrosurgical generator including a source of radio frequency energyand first second and third output connections connected to the first,second and third electrodes respectively of the electrosurgicalinstrument, the system further including a switching means, and acontroller, the controller being able to control the switching meanssuch as to selectively direct the radio frequency energy to either thefirst and second output connections and hence the first and secondelectrodes, or to the first and third output connections and hence thefirst and third electrodes, the first, second and third electrodes beingarranged such that if a straight line is drawn representing the shortestdistance between the first and second electrodes, no part of the thirdelectrode lies on that straight line, and if a straight line is drawnrepresenting the shortest distance between the first and thirdelectrodes, no part of the second electrode lies on that straight line,such that the third electrode is not in the current path between thefirst and second electrodes when the first and second electrodes are inuse, and the second electrode is not in the current path between thefirst and third electrodes when the first and third electrodes are inuse.

The invention will be further described, by way of example only, withreference to the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

In the drawings:

FIG. 1 is a schematic diagram of an electrosurgical system in accordancewith the present invention,

FIG. 2 is a schematic side view of the distal part of an electrosurgicalinstrument used in the system of FIG. 1,

FIG. 3 is a schematic block diagram of an electrosurgical generator usedin the system of FIG. 1,

FIGS. 4A and 4B are schematic block diagrams of the output stages of theelectrosurgical generator of FIG. 3, shown in differing stages ofoperation,

FIG. 5 is a schematic side view of the distal part of an alternativeembodiment of electrosurgical instrument used in the system of FIG. 1,

FIG. 6 is a partly sectioned schematic side view of the distal part of afurther alternative embodiment of electrosurgical instrument used in thesystem of FIG. 1,

FIG. 7 is a schematic plan view of the distal part of yet anotherembodiment of electrosurgical instrument used in the system of FIG. 1,

FIGS. 8 and 9 are perspective and sectional side views respectively of afurther embodiment of electrosurgical instrument in accordance with thepresent invention, and

FIGS. 10, 11, 12 and 13 are, respectively, an upper perspective view, alower perspective view, a plan view and a sectional side view of yetanother electrosurgical instrument in accordance with the invention, thecross-section of FIG. 13 being taken on the line A-A in FIG. 12.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS OF THE INVENTION

Referring to FIG. 1, a generator 10 has an output socket 10S providing aradio frequency (RF) output for an instrument 12 via a connection cord14. Activation of the generator may be performed from the instrument 12via a connection in cord 14 or by means of a footswitch unit 16, asshown, connected to the rear of the generator by a footswitch connectioncord 18. In the illustrated embodiment footswitch unit 16 has twofootswitches 16A and 16B for selecting a coagulation mode and a cuttingmode of the generator respectively. The generator front panel has pushbuttons 20 and 22 for respectively setting coagulation and cutting powerlevels, which are indicated in a display 24. Push buttons 26 areprovided as a means for selection between alternative coagulation andcutting waveforms.

FIG. 2 shows an embodiment of the instrument 12 in more detail. Theinstrument 12 has an insulated shaft 2 and a distal region 3. At thevery tip of the instrument is an active electrode 4, separated from afirst return electrode 6 by an insulating member 5, the insulatingmember serving to set back the return electrode axially with respect tothe active electrode 4. A second return electrode 7 is provided,separated from the first return electrode by an insulating member 8 suchthat the second return electrode is axially set back with respect to thefirst return electrode. In this way, the distance between the activeelectrode 4 and the first return electrode 6 is much smaller than thedistance between the active electrode 4 and the second return electrode7.

The exposed surface area of the active electrode 4 is smaller than thatof either the first return electrode 6 or the second return electrode 7.This helps to ensure that the electrode 4 acts as an active electrodeand the electrodes 6 and 7 act as return electrodes during theelectrosurgical cutting or coagulation process. The electrodes 4, 6 and7 are connected to the electrosurgical generator 10 via the connectioncord 14, where they are connected to different output connections, aswill now be described.

Referring to FIG. 3, the generator comprises a radio frequency (RF)output stage in the form of a power oscillator 60 having a pair ofoutput lines 60C for coupling via switching circuit 62 to the instrument12. Switching circuit 62 has first, second and third output connections62A, 62B and 62C for connection to the electrodes of the instrument, aswill be described later. Power is supplied to the oscillator 60 by aswitched mode power supply 66.

In the preferred embodiment, the RF oscillator 60 operates at about 400kHz, with any frequency from 300 kHz upwards into the HF range beingfeasible. The switched mode power supply typically operates at afrequency in the range of from 25 to 50 kHz. Coupled across the outputlines 60C is a voltage threshold detector 68 having a first output 68Acoupled to the switched mode power supply 66 and a second output 68Bcoupled to an “on” time control circuit 70. A micro-processor controller72 coupled to the operator controls and display (shown in FIG. 1) isconnected to a control input 66A of the power supply 66 for adjustingthe generator output power by supply voltage variation and to athreshold-set input 68C of the voltage threshold detector 68 for settingpeak RF output voltage limits.

In operation, the microprocessor controller 72 causes power to beapplied to the switched mode power supply 66 when electrosurgical poweris demanded by the surgeon operating an activation switch arrangementwhich may be provided on a hand-piece or footswitch (see FIG. 1). Aconstant output voltage threshold is set independently of the supplyvoltage via input 68C according to control settings on the front panelof the generator (see FIG. 1). Typically, for desiccation or coagulationthe threshold is set at a desiccation threshold value between 150 voltsand 200 volts. When a cutting or vaporisation output is required thethreshold is set to a value in the range of from 250 or 300 volts to 600volts. These voltage values are peak values. Their being peak valuesmeans that for desiccation or coagulation at least it is preferable tohave an output RF waveform of low crest factor to give maximum powerbefore the voltage is clamped at the values given. Typically a crestfactor of 1.5 or less is achieved.

When the generator is first activated, the status of the control input60I of the RF oscillator 60 (which is connected to the “on” time controlcircuit 70) is “on”, such that the power switching device which formsthe oscillating element of the oscillator 60 is switched on for amaximum conduction period during each RF oscillation cycle. The powerdelivered to the tissue depends partly on the supply voltage applied tothe RF oscillator 60 from the switched mode power supply 66 and partlyon the tissue impedance. The voltage threshold for a desiccation outputis set to cause trigger signals to be sent to the “on” time controlcircuit 70 and to the switched mode power supply 66 when the voltagethreshold is reached. The “on” time control circuit 70 has the effect ofvirtually instantaneously reducing the “on” time of the RFoscillator-switching device. Simultaneously, the switched mode powersupply is disabled so that the voltage supplied to oscillator 60 beginsto fall. The operation of the generator in this way is described indetail in European Published Patent Application No. 0754437, thedisclosure of which is hereby incorporated by way of reference.

The output connections 62A, 62B and 62C from the generator 10 areelectrically connected to the three electrodes 4, 6 and 7 (FIG. 2)respectively, via lead 14. When it is desired to operate the instrument12 in a cutting mode, footswitch 16A is depressed which causes a signalto be sent to the controller 72 which sets the switching circuit 62 its“cut” position. This is illustrated in FIG. 4A, in which the signalsfrom the oscillator 60 are connected between the first and second outputconnections 62A, 62B. This means that the RF power signal is appliedbetween the cutting electrode 4 and the first return electrode 6. Thethird or output connection 62C (and hence second return electrode 7) isnot energized.

At the same time as the controller 72 sets the switching circuit to theposition in FIG. 4A, it also sends a signal via line 68C to the voltagethreshold detector 68 to set the peak output voltage limit to arelatively high “cutting” level. The control of this cutting signal isdescribed in more detail in EP 0754437, referred to earlier. In cuttingmode, the output from the generator is a relatively high voltage, with aconsequent low current level, and the relatively small distance betweenthe active electrode 4 and 6 and the first return electrode ensures thatthe electrode assembly fires up and cuts tissue, even if the tip of theinstrument is immersed in an electrically-conductive fluid.

Alternatively, when it is desired to operate the instrument 12 in acoagulation mode, footswitch 16B is depressed which causes thecontroller 72 to set the switching circuit 62 to its “coag” state, asillustrated in FIG. 4B. In this set-up, the power signals from theoscillator are connected between the first and third output connections62A, 62C. This means that the RF power signal is applied between theactive electrode 4 and the second return electrode 7. At the same timethe controller sends a signal to the voltage threshold detector 68 toset the peak output voltage limit to a relatively lower “coagulating”level, again as more particularly described in EP 0754437. In “coag”mode, the output from the generator is a relatively lower voltage, witha corresponding relatively higher current, and the relatively largerdistance between the active and second return electrodes 4 and 7 ensuresthat an effective area of coagulation is produced.

In an alternative switching arrangement (not shown), when the instrument12 is to be operated in coagulation mode, the switching circuit connectsthe power signals from the oscillator between the first outputconnection 62A and both of the second and third output connections 62Band 62C. In this way, both return electrodes 6, 7 are used in thecoagulation process, giving both relatively precise coagulation betweenthe active electrode 4 and the first return electrode 6, and relativelybroad coagulation between the active electrode 4 and the second returnelectrode 7.

FIG. 5 shows an alternative instrument 12 in which both an activeelectrode 4 and the first return electrode 6 are located at the distaltip of the instrument. A single insulating member 5 is provided toseparate these two electrodes 4, 6 from each other, and also from asecond return electrode 7 which is axially set back from the active andfirst return electrodes 4, 6. The operation of the instrument is similarto that described previously, in that cutting signals from the generator10 are supplied to the first and second output connections 62A, 62B, andhence to the active and first return electrodes 4, 6. In this way,electrosurgical cutting takes place between the two electrodes 4, 6 atthe distal tip of the instrument. In this situation the first returnelectrode 6 is acting as a return electrode for the cutting operation.

When coagulation is required, the coagulation output from the generatoris supplied to the first and third output connections 62A, 62C and henceto the active and second return electrodes 4, 7. Optionally in thisarrangement the first and second output connections 62A, 62B can beconnected together during the coagulation phase, so that coagulationtakes place between either or both of the active and first returnelectrodes 4, 6 on the one hand, and the second return electrode 7 onthe other hand. In this situation, the first return electrode 6 isacting as an additional active electrode for the coagulation operation.

FIG. 6 shows an alternative embodiment in which the active electrode 4is present at the distal tip of the instrument 12, and the first returnelectrode 6 surrounds the active electrode 4 as shown. In this case, thefirst return electrode 6 has an annular surface exposed on a distallydirected surface portion of the instrument distal region 3 Theinsulating member 5 separates the active electrode 4 from the firstreturn electrode 6, and the other insulating member 8 separates thesetwo electrodes 4, 6 from an axially set-back second return electrode 7.The operation of this device is as previously described, withelectrosurgical cutting taking place between the active and first returnelectrodes 4 and 6 over the relatively short distance therebetween, withelectrosurgical coagulation taking place between the active and secondreturn electrodes 4, 7, over a much larger distance.

FIG. 7 shows a four-electrode instrument, using a combination of thefeatures from previous embodiments shown in FIGS. 2 and 5. An activeelectrode 4 and first return electrode 6 are both present on the tip ofthe instrument 12, separated by insulating member 5 from each other andalso from a second return electrode 7 which is axially set back from thefirst two electrodes 4, 6. However, there is additionally provided athird return electrode 9 axially set back from the second returnelectrode 7 by means of a further insulating member 11. The generatorhas a further output connection which can be selected by the switchingmeans 62 (see FIG. 3) to connect to the third return electrode 9. Inthis way, the instrument has three different settings, “cut”, “focusedcoagulation” and “broad coagulation”. In the cut mode, the cutting RFwaveform is directed between the active electrode 4 and the first returnelectrode 6. In the focused coagulation mode, a coagulating RF waveformis directed between the active electrode and the second return electrode7. In the broad coagulation mode, the coagulating RF waveform isdirected between the active electrode and the third return electrode 9.In each case, the distance between the active electrode and eachrespective return electrode increases, such that the broad coagulationtakes place over an even larger area of tissue than the focusedcoagulation.

FIGS. 8 and 9 show an alternative embodiment of instrument based on thatdisclosed in published US Patent Application No. US2009/0048592, theentire contents of which are hereby incorporated by reference. In thisinstrument, the active electrode 4 is located within a ceramic insulator36. The active electrode 4 is housed within a chamber 33 provided in theceramic insulator 36. This tissue treatment electrode 4 is formed oftungsten or an alloy of tungsten and platinum. It is formed with asuction aperture 4 a, and is provided with a respective projection 4 bat each of its corners, the projections being provided to concentratethe electric field in each of the corners of the active electrode. Theprojections 4 b also serve to create a small separation between theplanar surface 30 of the active electrode 4 and the tissue to betreated. This allows conductive fluid to circulate over the planarsurface, and avoids overheating of the electrode or the tissue.

As shown in FIG. 9, the active electrode 4 comprises an upper portion 35including the planar surface 30 and the projections 4 b, and a lowerportion 31 including a shaped keel portion 32. To assemble theinstrument, the active electrode 4 is lowered into a chamber 33 presentwithin the ceramic insulator 36. A suction tube 37 is then pushedforward to locate over the keel portion 32 of the active electrode andsecure it in place. The forward movement of the suction tube 37 pushesthe active electrode 4 forwardly in the chamber 33, thereby locking theactive electrode in place.

In order to reduce the problems of vapour bubble production and toassist with the removal of particulate material (such as tissue debris)from the region surrounding the tissue treatment electrode 4, theinstrument is provided with a suction pump (not shown) which can removevapour bubbles via the shaft of the instrument through the aperture 4 ain the active electrode. The suction tube 37 is made of anelectrically-conductive material such as stainless steel or gold-platedcopper, and connects the suction aperture 4 a to the suction pump. Thetube 37 also constitutes means for electrically connecting the activeelectrode 4 to the generator 10.

The return electrode 7 is constituted by the distal end portion of theshaft 40, and a polytetrafluorethylene, a polyolefin, a polyester orethylene tetrafluoroethylene sleeve 41 surrounds the proximal portion ofthe shaft 40 adjacent to the return electrode 7. The suction tube 37 isformed with a longitudinal slot 42 at its distal end. As shown in thefigures, the distal end of the suction tube 37 extends into the chamber33 defined by the ceramic insulator 36 beneath the active electrode 4.The slot 42 is contiguous with the aperture 4 a in the active electrode4, which slopes through the tissue treatment electrode at an angle ofapproximately 45 degrees. A blind recess 43 is provided in the electrode4. This recess 43 is provided purely to allow for the automated assemblyof the electrosurgical instrument, and does not provide a suctionaperture as it does not pass all the way through the electrode 4.

The ceramic insulator 36 is surrounded with a metallic cowl 44, whichforms the first return electrode 6 and which is connected via an outerlead 45 to the generator 10, and to the switching circuit 62 describedabove with reference to FIGS. 4A and 4B. When the instrument is beingused to cut tissue, the switching circuit delivers the RF power signalbetween the active electrode 4 and the cowl 44 (i.e. the first returnelectrode 6). However, when the instrument is being used to coagulatetissue, the switching circuit delivers the RF power signal between theactive electrode 4 and the second return electrode 7. The distancebetween the active and first electrodes 4, 6 is less than that betweenthe active and second return electrodes 4, 7, so that a relatively smallelectrode separation exists when the instrument is being used to cuttissue, whereas a relatively larger electrode separation exists when theinstrument is being used to coagulate tissue.

It will be appreciated that if a straight line is drawn representing theshortest distance between the active electrode 4 and the second returnelectrode 7, no part of the first return electrode 6 (or the cowl 44)lies on that line. This means that the first return electrode 6 (or thecowl 44) is not in the current path between the active electrode 4 andthe second return electrode 7 when the instrument 12 is being used tocoagulate tissue. In this instance the current flows through tissue orconductive fluid between the active and second return electrodes 4, 7without being diverted to or affected by the cowl 44. Similarly, if astraight line is drawn representing the shortest distance between theactive electrode 4 and the cowl 44, no part of the second returnelectrode 7 lies on that line. This means that the second electrode 7 isnot in the current path between the active electrode 4 and the cowl 44when the instrument is being used to cut tissue. In this instance thecurrent flows through tissue or conductive fluid between the activeelectrode 4 and the return electrode or cowl 44 without being divertedto or affected by the second return electrode 7.

In an alternative embodiment shown in FIGS. 10, 11, 12 and 13 the activeelectrode 4 has an additional exposed tissue treatment surface 46 offsetby 180° with respect to the planar surface 30, i.e. oppositely directedwith respect to surface 30. In the instrument of FIGS. 10 and 11, theconductive suction tube 37 is in electrical contact with both the activeelectrode body portion 31 associated with the tissue treatment surface30, but also with an opposite body portion 47 associated with the tissuetreatment surface 46. In this way, both active electrode tissuetreatment surfaces 30, 46 are simultaneously activated when an RF powersignal is supplied to the instrument. As before, a cowl 44 acts as areturn electrode for the tissue treatment surfaces 30 and 46 when theinstrument is being used to cut tissue. The distal end portion 7 of theshaft acts as the return electrode when the tissue treatment surfaces 30and 46 are being used to coagulate tissue. Surface 46 has a smallersurface area as compared with surface 30, and so the instrument isdesigned to be used to cut tissue using surface 46 and to coagulatetissue using surface 30. In this way, the user of the instrument canrotate the instrument through 180° to bring each of the surfaces 30 or46 into contact with the tissue to be treated, depending on whethertissue cutting or tissue coagulation is desired.

It will be seen that, as with the embodiment described above withreference to FIGS. 8 and 9, the instrument of FIGS. 10 to 11 provides anelectrode arrangement in which the return electrodes 44, 7 are offsetfrom one another. If a straight line is drawn representing the shortestdistance between the tissue treatment surface 30 and the second returnelectrode 7, no part of the first return electrode, the cowl, 44 lies onthat line. Similarly, if a straight line is drawn representing theshortest distance between the tissue treatment surface 46 and the secondreturn electrode 7, no part of the cowl 44 lies on that line. In thisway, the cowl 44 does not interfere with the current path between thetreatment surfaces 30, 46 and the second return electrode 7 when theinstrument is being used to coagulate tissue. In similar fashion, if astraight line is drawn representing the shortest distance between thesurface 30 and the cowl 44, no part of the second return electrode 7lies on that line. Similarly, if a straight line is drawn representingthe shortest distance between the surface 46 and the cowl 44, no part ofthe second return electrode 7 lies on that line. In this way, the secondreturn electrode 7 does not interfere with the current paths between thetissue treatment surfaces 30, 46 and the cowl 44 when the instrument isbeing used to cut tissue.

It will be appreciated that further combinations of electrodes andgenerator switching are possible without departing from the scope of thepresent invention. The instruments can be employed directly contactingtissue as dry-field instruments, or used immersed in a conductive fluidas wet-field instruments. The switching circuit 62 can be used simply toswitch between the cut and coagulation modes, or can be used to providea blended cut and coagulation mode in which it alternates rapidlybetween the two states, as described in more detail in U.S. Pat. No.6,966,907, the contents of which are incorporated by reference. Thoseskilled in the art will appreciate how these different variations can beemployed, depending on the requirements of each procedure or surgeonpreference.

1. An electrosurgical system including: an electrosurgical instrumentand an electrosurgical generator, the electrosurgical instrumentincluding at least first, second and third electrodes in fixedrelationship to each other, each spaced from each other by insulatingmembers therebetween, the first electrode having a characteristic suchthat it is adapted to constitute an active electrode, the secondelectrode having a characteristic such that it is adapted to constitutea first return electrode, and the third electrode having acharacteristic such that it is adapted to constitute a second returnelectrode, the electrosurgical generator including a source of radiofrequency energy and first second and third output connections connectedto the first, second and third electrodes, respectively, of theelectrosurgical instrument, a switching circuit, and a controller, thecontroller being able to control the switching circuit so as toselectively direct the radio frequency energy to either the first andsecond output connections, and hence, the first and second electrodes,or to the first and third output connections, and hence, the first andthird electrodes, the first, second and third electrodes being arranged,such that the third electrode is not in the current path between thefirst and second electrodes when the first and second electrodes are inuse, and the second electrode is not in the current path between thefirst and third electrodes when the first and third electrodes are inuse.
 2. An electrosurgical system according to claim 1, wherein thespacing between the first and third electrodes is greater than thatbetween the first and second electrodes.
 3. An electrosurgical systemaccording to claim 1, wherein the area of the first electrode is lessthan that of the third electrode.
 4. An electrosurgical system accordingto claim 3 wherein the area of the first electrode is less than that ofthe second electrode.
 5. An electrosurgical system according to claim 4wherein an area of the first electrode and an area of the secondelectrodes are each individually less than an area of the thirdelectrode.
 6. An electrosurgical system according to claim 1, whereinthe third electrode is axially set back with respect to the first andsecond electrodes along the longitudinal axis of the electrosurgicalinstrument.
 7. An electrosurgical instrument according to claim 1,wherein the second electrode comprises a cowl wrapped around the distalend of the instrument.
 8. An electrosurgical system according to claim1, wherein the electrosurgical generator includes a source of radiofrequency energy capable of producing either a coagulating RF waveformor a cutting RF waveform, the system further including a switch, and aswitching circuit activated by the switch, the switching circuit beingsuch that when a cutting RF waveform is selected, the switching circuitdirects the cutting RF waveform between the first and second outputconnections, and hence, the first and second electrodes, and when acoagulating RF waveform is selected, the switching circuit directs thecoagulating RF waveform between the first and third output connections,and hence, the first and third electrodes.
 9. An electrosurgical systemaccording to claim 1, wherein the first, second and third electrodes arearranged, such that if a straight line is drawn representing theshortest distance between the first and second electrodes, no part ofthe third electrode lies on that straight line, and if a straight lineis drawn representing the shortest distance between the first and thirdelectrodes, no part of the second electrode lies on that straight line.